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BERGEN PHARMACY
PED393303-00 THE CHILDREN'S HOSPITAL OF PHILADELPHIA
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Covered Entity Details
Entity Name
THE CHILDREN'S HOSPITAL OF PHILADELPHIA
Subdivision Name
Type
Children's Hospital
340B ID
PED393303-00
Entity Address
3401 Civic Center Blvd
PHILADELPHIA, PA 19104
Medicare Provider Number
393303
Participating Start Date
1/1/2010
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
BERGEN PHARMACY
Pharmacy Address
39 E MOUNT PLEASANT AVE
LIVINGSTON, NJ 07039
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
THOMAS J. TODOROW, EXECUTIVE VICE PRESIDENT FINANCE AND CHIEF FINANCIAL OFFICER
(267) 426-6957
Contract Pharmacy Representative
Bergen Pharmacy
Devang Nagrecha, President
(908) 994-9700
Signed By Date
1/15/2019
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